|
GRAFT PROPATEN 6*50 W/RING
|
Facility
|
IP
|
$9,865.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,959.70 |
| Max. Negotiated Rate |
$9,471.02 |
| Rate for Payer: Aetna Commercial |
$7,596.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,695.21
|
| Rate for Payer: Cash Price |
$4,932.82
|
| Rate for Payer: Cigna Commercial |
$8,188.49
|
| Rate for Payer: First Health Commercial |
$9,372.37
|
| Rate for Payer: Humana Commercial |
$8,385.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,089.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,280.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,959.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,681.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,399.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,892.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,583.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,807.30
|
| Rate for Payer: PHCS Commercial |
$9,471.02
|
| Rate for Payer: United Healthcare All Payer |
$8,681.77
|
|
|
GRAFT PROPATEN 6*50 W/RING
|
Facility
|
OP
|
$9,865.65
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,959.70 |
| Max. Negotiated Rate |
$9,471.02 |
| Rate for Payer: Aetna Commercial |
$7,596.55
|
| Rate for Payer: Anthem Medicaid |
$3,392.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,695.21
|
| Rate for Payer: Cash Price |
$4,932.82
|
| Rate for Payer: Cigna Commercial |
$8,188.49
|
| Rate for Payer: First Health Commercial |
$9,372.37
|
| Rate for Payer: Humana Commercial |
$8,385.80
|
| Rate for Payer: Humana KY Medicaid |
$3,392.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,427.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,089.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,280.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,959.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,460.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,681.77
|
| Rate for Payer: Ohio Health Group HMO |
$7,399.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,892.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,583.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,807.30
|
| Rate for Payer: PHCS Commercial |
$9,471.02
|
| Rate for Payer: United Healthcare All Payer |
$8,681.77
|
|
|
GRAFT PROPATEN 6*70 W/RING
|
Facility
|
IP
|
$13,214.49
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,964.35 |
| Max. Negotiated Rate |
$12,685.91 |
| Rate for Payer: Aetna Commercial |
$10,175.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,307.30
|
| Rate for Payer: Cash Price |
$6,607.24
|
| Rate for Payer: Cigna Commercial |
$10,968.03
|
| Rate for Payer: First Health Commercial |
$12,553.77
|
| Rate for Payer: Humana Commercial |
$11,232.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,835.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,752.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,964.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,628.75
|
| Rate for Payer: Ohio Health Group HMO |
$9,910.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,571.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,496.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,118.00
|
| Rate for Payer: PHCS Commercial |
$12,685.91
|
| Rate for Payer: United Healthcare All Payer |
$11,628.75
|
|
|
GRAFT PROPATEN 6*70 W/RING
|
Facility
|
OP
|
$13,214.49
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,964.35 |
| Max. Negotiated Rate |
$12,685.91 |
| Rate for Payer: Aetna Commercial |
$10,175.16
|
| Rate for Payer: Anthem Medicaid |
$4,544.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,307.30
|
| Rate for Payer: Cash Price |
$6,607.24
|
| Rate for Payer: Cigna Commercial |
$10,968.03
|
| Rate for Payer: First Health Commercial |
$12,553.77
|
| Rate for Payer: Humana Commercial |
$11,232.32
|
| Rate for Payer: Humana KY Medicaid |
$4,544.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,590.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,835.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,752.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,964.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,635.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,628.75
|
| Rate for Payer: Ohio Health Group HMO |
$9,910.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,571.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,496.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,118.00
|
| Rate for Payer: PHCS Commercial |
$12,685.91
|
| Rate for Payer: United Healthcare All Payer |
$11,628.75
|
|
|
GRAFT PROPATEN 6*80 STD WALL
|
Facility
|
OP
|
$11,236.36
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.91 |
| Max. Negotiated Rate |
$10,786.91 |
| Rate for Payer: Aetna Commercial |
$8,652.00
|
| Rate for Payer: Anthem Medicaid |
$3,864.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,764.36
|
| Rate for Payer: Cash Price |
$5,618.18
|
| Rate for Payer: Cigna Commercial |
$9,326.18
|
| Rate for Payer: First Health Commercial |
$10,674.54
|
| Rate for Payer: Humana Commercial |
$9,550.91
|
| Rate for Payer: Humana KY Medicaid |
$3,864.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,903.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,213.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,292.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,370.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,941.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,888.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,427.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,989.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,775.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,753.09
|
| Rate for Payer: PHCS Commercial |
$10,786.91
|
| Rate for Payer: United Healthcare All Payer |
$9,888.00
|
|
|
GRAFT PROPATEN 6*80 STD WALL
|
Facility
|
IP
|
$11,236.36
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,370.91 |
| Max. Negotiated Rate |
$10,786.91 |
| Rate for Payer: Aetna Commercial |
$8,652.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,764.36
|
| Rate for Payer: Cash Price |
$5,618.18
|
| Rate for Payer: Cigna Commercial |
$9,326.18
|
| Rate for Payer: First Health Commercial |
$10,674.54
|
| Rate for Payer: Humana Commercial |
$9,550.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,213.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,292.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,370.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,888.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,427.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,989.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,775.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,753.09
|
| Rate for Payer: PHCS Commercial |
$10,786.91
|
| Rate for Payer: United Healthcare All Payer |
$9,888.00
|
|
|
GRAFT PROPATEN INTERING 6*40
|
Facility
|
IP
|
$8,482.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,544.69 |
| Max. Negotiated Rate |
$8,143.01 |
| Rate for Payer: Aetna Commercial |
$6,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,616.19
|
| Rate for Payer: Cash Price |
$4,241.15
|
| Rate for Payer: Cigna Commercial |
$7,040.31
|
| Rate for Payer: First Health Commercial |
$8,058.19
|
| Rate for Payer: Humana Commercial |
$7,209.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,955.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,259.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,464.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,361.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,785.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,852.79
|
| Rate for Payer: PHCS Commercial |
$8,143.01
|
| Rate for Payer: United Healthcare All Payer |
$7,464.42
|
|
|
GRAFT PROPATEN INTERING 6*40
|
Facility
|
OP
|
$8,482.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,544.69 |
| Max. Negotiated Rate |
$8,143.01 |
| Rate for Payer: Aetna Commercial |
$6,531.37
|
| Rate for Payer: Anthem Medicaid |
$2,917.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,616.19
|
| Rate for Payer: Cash Price |
$4,241.15
|
| Rate for Payer: Cigna Commercial |
$7,040.31
|
| Rate for Payer: First Health Commercial |
$8,058.19
|
| Rate for Payer: Humana Commercial |
$7,209.95
|
| Rate for Payer: Humana KY Medicaid |
$2,917.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,946.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,955.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,259.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,975.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,464.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,361.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,785.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,852.79
|
| Rate for Payer: PHCS Commercial |
$8,143.01
|
| Rate for Payer: United Healthcare All Payer |
$7,464.42
|
|
|
GRAFT PROPATEN INTERING 8*40
|
Facility
|
OP
|
$8,482.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,544.69 |
| Max. Negotiated Rate |
$8,143.01 |
| Rate for Payer: Aetna Commercial |
$6,531.37
|
| Rate for Payer: Anthem Medicaid |
$2,917.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,616.19
|
| Rate for Payer: Cash Price |
$4,241.15
|
| Rate for Payer: Cigna Commercial |
$7,040.31
|
| Rate for Payer: First Health Commercial |
$8,058.19
|
| Rate for Payer: Humana Commercial |
$7,209.95
|
| Rate for Payer: Humana KY Medicaid |
$2,917.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,946.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,955.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,259.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,975.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,464.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,361.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,785.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,852.79
|
| Rate for Payer: PHCS Commercial |
$8,143.01
|
| Rate for Payer: United Healthcare All Payer |
$7,464.42
|
|
|
GRAFT PROPATEN INTERING 8*40
|
Facility
|
IP
|
$8,482.30
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,544.69 |
| Max. Negotiated Rate |
$8,143.01 |
| Rate for Payer: Aetna Commercial |
$6,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,616.19
|
| Rate for Payer: Cash Price |
$4,241.15
|
| Rate for Payer: Cigna Commercial |
$7,040.31
|
| Rate for Payer: First Health Commercial |
$8,058.19
|
| Rate for Payer: Humana Commercial |
$7,209.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,955.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,259.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,544.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,464.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,361.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,785.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,379.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,852.79
|
| Rate for Payer: PHCS Commercial |
$8,143.01
|
| Rate for Payer: United Healthcare All Payer |
$7,464.42
|
|
|
GRAFT PROPATEN RING TW 8*80
|
Facility
|
OP
|
$13,809.03
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,142.71 |
| Max. Negotiated Rate |
$13,256.67 |
| Rate for Payer: Aetna Commercial |
$10,632.95
|
| Rate for Payer: Anthem Medicaid |
$4,748.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,771.04
|
| Rate for Payer: Cash Price |
$6,904.52
|
| Rate for Payer: Cigna Commercial |
$11,461.49
|
| Rate for Payer: First Health Commercial |
$13,118.58
|
| Rate for Payer: Humana Commercial |
$11,737.68
|
| Rate for Payer: Humana KY Medicaid |
$4,748.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,797.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,323.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,191.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,142.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,844.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,151.95
|
| Rate for Payer: Ohio Health Group HMO |
$10,356.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,047.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,013.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,528.23
|
| Rate for Payer: PHCS Commercial |
$13,256.67
|
| Rate for Payer: United Healthcare All Payer |
$12,151.95
|
|
|
GRAFT PROPATEN RING TW 8*80
|
Facility
|
IP
|
$13,809.03
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,142.71 |
| Max. Negotiated Rate |
$13,256.67 |
| Rate for Payer: Aetna Commercial |
$10,632.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,771.04
|
| Rate for Payer: Cash Price |
$6,904.52
|
| Rate for Payer: Cigna Commercial |
$11,461.49
|
| Rate for Payer: First Health Commercial |
$13,118.58
|
| Rate for Payer: Humana Commercial |
$11,737.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,323.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,191.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,142.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,151.95
|
| Rate for Payer: Ohio Health Group HMO |
$10,356.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,047.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,013.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,528.23
|
| Rate for Payer: PHCS Commercial |
$13,256.67
|
| Rate for Payer: United Healthcare All Payer |
$12,151.95
|
|
|
GRAFT PROPATEN RMVL RING 8MM*4
|
Facility
|
OP
|
$8,467.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.31 |
| Max. Negotiated Rate |
$8,128.99 |
| Rate for Payer: Aetna Commercial |
$6,520.13
|
| Rate for Payer: Anthem Medicaid |
$2,912.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,604.81
|
| Rate for Payer: Cash Price |
$4,233.85
|
| Rate for Payer: Cigna Commercial |
$7,028.19
|
| Rate for Payer: First Health Commercial |
$8,044.31
|
| Rate for Payer: Humana Commercial |
$7,197.55
|
| Rate for Payer: Humana KY Medicaid |
$2,912.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,941.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,943.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,249.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,540.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,970.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,451.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,350.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,774.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,366.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,842.71
|
| Rate for Payer: PHCS Commercial |
$8,128.99
|
| Rate for Payer: United Healthcare All Payer |
$7,451.58
|
|
|
GRAFT PROPATEN RMVL RING 8MM*4
|
Facility
|
IP
|
$8,467.70
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,540.31 |
| Max. Negotiated Rate |
$8,128.99 |
| Rate for Payer: Aetna Commercial |
$6,520.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,604.81
|
| Rate for Payer: Cash Price |
$4,233.85
|
| Rate for Payer: Cigna Commercial |
$7,028.19
|
| Rate for Payer: First Health Commercial |
$8,044.31
|
| Rate for Payer: Humana Commercial |
$7,197.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,943.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,249.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,540.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,451.58
|
| Rate for Payer: Ohio Health Group HMO |
$6,350.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,774.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,366.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,842.71
|
| Rate for Payer: PHCS Commercial |
$8,128.99
|
| Rate for Payer: United Healthcare All Payer |
$7,451.58
|
|
|
GRAFT PROPATEN STD R/RNG 90*40
|
Facility
|
IP
|
$21,440.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,432.00 |
| Max. Negotiated Rate |
$20,582.40 |
| Rate for Payer: Aetna Commercial |
$16,508.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,723.20
|
| Rate for Payer: Cash Price |
$10,720.00
|
| Rate for Payer: Cigna Commercial |
$17,795.20
|
| Rate for Payer: First Health Commercial |
$20,368.00
|
| Rate for Payer: Humana Commercial |
$18,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,580.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,822.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,867.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,652.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,793.60
|
| Rate for Payer: PHCS Commercial |
$20,582.40
|
| Rate for Payer: United Healthcare All Payer |
$18,867.20
|
|
|
GRAFT PROPATEN STD R/RNG 90*40
|
Facility
|
OP
|
$21,440.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,432.00 |
| Max. Negotiated Rate |
$20,582.40 |
| Rate for Payer: Aetna Commercial |
$16,508.80
|
| Rate for Payer: Anthem Medicaid |
$7,373.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,723.20
|
| Rate for Payer: Cash Price |
$10,720.00
|
| Rate for Payer: Cigna Commercial |
$17,795.20
|
| Rate for Payer: First Health Commercial |
$20,368.00
|
| Rate for Payer: Humana Commercial |
$18,224.00
|
| Rate for Payer: Humana KY Medicaid |
$7,373.22
|
| Rate for Payer: Kentucky WC Medicaid |
$7,448.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,580.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,822.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,432.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,521.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,867.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,652.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,793.60
|
| Rate for Payer: PHCS Commercial |
$20,582.40
|
| Rate for Payer: United Healthcare All Payer |
$18,867.20
|
|
|
GRAFT PROPATN ACUSL DIA 6*40
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem Medicaid |
$2,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Humana KY Medicaid |
$2,638.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,691.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
GRAFT PROPATN ACUSL DIA 6*40
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
GRAFT PROX EXT ZENITH 38*77
|
Facility
|
IP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT PROX EXT ZENITH 38*77
|
Facility
|
OP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem Medicaid |
$8,422.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Humana KY Medicaid |
$8,422.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,508.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,591.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT PROX EXT ZENITH 40*81*75
|
Facility
|
IP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT PROX EXT ZENITH 40*81*75
|
Facility
|
OP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem Medicaid |
$8,422.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Humana KY Medicaid |
$8,422.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,508.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,591.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT PROX EXT ZENITH 42*81
|
Facility
|
IP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT PROX EXT ZENITH 42*81
|
Facility
|
OP
|
$24,492.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,347.75 |
| Max. Negotiated Rate |
$23,512.80 |
| Rate for Payer: Aetna Commercial |
$18,859.22
|
| Rate for Payer: Anthem Medicaid |
$8,422.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,104.15
|
| Rate for Payer: Cash Price |
$12,246.25
|
| Rate for Payer: Cigna Commercial |
$20,328.78
|
| Rate for Payer: First Health Commercial |
$23,267.88
|
| Rate for Payer: Humana Commercial |
$20,818.62
|
| Rate for Payer: Humana KY Medicaid |
$8,422.97
|
| Rate for Payer: Kentucky WC Medicaid |
$8,508.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,083.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,075.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,347.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,591.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,553.40
|
| Rate for Payer: Ohio Health Group HMO |
$18,369.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,594.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,308.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,899.83
|
| Rate for Payer: PHCS Commercial |
$23,512.80
|
| Rate for Payer: United Healthcare All Payer |
$21,553.40
|
|
|
GRAFT SM REM RING 6*40
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
